Parents & Teachers



Tobacco use usually begins in early adolescence, typically by age 16. Almost all first use occurs before young people graduate from high school. If adolescents can be kept tobacco-free, most will remain tobacco-free for the rest of their lives.

  • At least 3.1 million adolescents are current smokers. Smoking is most common among 17- and 18-year-olds; about 25 percent of these young people smoke.
  • By age 18, about two-thirds of young people in the United States have tried smoking.
  • Nicotine is generally the first drug used by young people who use alcohol, marijuana, and harder drugs.
  • Adolescent tobacco use is associated with being in fights, carrying weapons, and engaging in higher-risk sexual behavior. The younger a person begins smoking, the greater the risk for developing the numerous illnesses associated with smoking. Even teens experience adverse health effects:
  • General decrease in physical fitness.
  • Increased coughing and phlegm.
  • Greater susceptibility to and severity of respiratory illnesses.
  • Early development of artery disease, a possible precursor of heart disease.
  • Slower rate of lung growth---and, by adulthood, possible reduced level of normal lung function.

Smokeless Tobacco

According to the Centers for Disease Control, smokeless tobacco is definitely not a safe alternative to smoking. Many young people, however, do not know that even in the short term, smokeless tobacco is a dangerous alternative to cigarettes. Adolescent users of smokeless tobacco:

  • Have early signs of gum disease.
  • Develop lesions in their oral soft tissue - a possible warning sign of cancer.
  • Are much more likely than nonusers to become cigarette smokers.

Second-hand Smoke

Exposure to Environmental Tobacco Smoke and Cotinine Levels

The National Institutes of Health's National Toxicology Program's 9th issue of the Report on Carcinogens listed ETS as a "known" human carcinogen, which indicates that there is a cause and effect relationship between exposure and human cancer incidence.

ETS is classified as a Group A carcinogen (known to cause cancer in humans) under the EPA's carcinogen assessment guidelines. Exposure to ETS causes lung cancer and has been linked to an increased risk for heart disease in nonsmokers.

ETS causes about 3,000 lung cancer deaths annually among adult nonsmokers. Scientific studies have also estimated that ETS accounts for as many as 62,000 deaths from coronary heart disease annually in the United States. More research is needed to know exactly how recent changes in ETS exposure may affect lung cancer rates among adult nonsmokers.

ETS causes serious respiratory problems in children, such as greater number and severity of asthma attacks and lower respiratory tract infections. ETS exposure increases the risk for sudden infant death syndrome (SIDS) and middle ear infections for children.

Cotinine is a major metabolite of nicotine. Exposure to nicotine can be measured by analyzing the cotinine levels in the blood, saliva, or urine. Since nicotine is highly specific for tobacco smoke, serum cotinine levels track exposure to tobacco smoke and its toxic constituents.

In 1991, data showed that nearly 90 percent of the U.S. population had measurable levels of serum cotinine in their blood. The Centers for Disease Control and Prevention's National Report on Human Exposure to Environmental Chemicals found more than a 75 percent decrease in median cotinine (metabolized nicotine) levels for nonsmokers in the United States since 1991.

Children and teenagers, 3-19 years old, had higher levels of cotinine than did adults, 20 years old and above.

The dramatic declines in serum cotinine levels among nonsmokers are a good indication that efforts to ensure clean indoor air through smoking restrictions in workplaces, restaurants and other public places are working. However, there are still too many people, especially young people, who continue to be exposed to environmental tobacco smoke (ETS).

Second-hand Smoke in Your Home

Those most affected by secondhand smoke are children. Because their bodies are still developing, exposure to the poisons in secondhand smoke puts children in danger of severe respiratory diseases and can hinder the growth of their lungs. On top of that, the effects can last a lifetime.

Ventilation systems in homes cannot filter and circulate air well enough to eliminate secondhand smoke. Blowing smoke away from children, going into another room to smoke, or opening a window may help reduce children's exposure but will not protect them from the dangers of secondhand smoke.

Safety Links On This Topic

Sources: The safety tips in this section were compiled from the following great internet resources: Centers for Disease Control and Prevention (